(Also known as The Time Göran Hijacked My Podcast and Made It Better) 

I was hosting a podcast, and I had a plan. 

I was hosting three leaders whose work I deeply respected and admired: April Kyle from Southcentral Foundation in Alaska, Sarah Woolnough from The King’s Fund in the United Kingdom, and Göran Henriks from Jönköping, Sweden. 

I wanted to ask them what it would take for health systems to continue learning, adapting and renewing themselves in a changing world. A good question, I thought. 

Then, Göran had other ideas. 

He asked if we could start with a different question instead: what is one assumption about the future of health and healthcare that leaders should question more deeply?

And just like that, my plan left the room. For a brief moment, I considered leaving the room with it. But the question Göran raised was interesting, it had life in it. And when Göran offers a live thread of curiosity, I have found the wiser option is usually to follow it. 

So, I said yes, and the conversation was so much better for it.  

As we were recording, my immediate takeaway was simple and personal: what assumptions am I holding that I do not even know I am holding. It was only later, after listening to the recording and editing it, that I heard a deeper pattern. The conversation was not only about assumptions. It was also about whether health systems are willing to learn. 

To challenge an assumption is not simply to name a flaw in someone’s thinking. It is to ask where the system may have stopped learning. From whom has it stopped learning? What has it stopped noticing? What has it already decided is not worth questioning? 

April, Sarah and Göran each approached this question of learning from a different angle.   

April challenged the assumption that the people with the most experience or the biggest titles have the most valuable things to say. If health and wellness happen in the life patterns of people, families and communities, then leadership must mean creating ways for the system to listen in relationship with the community and allowing that listening to guide improvement. 

Sarah challenged the assumption that describing change is enough to make change happen. But change does not happen simply because it has been described. This is where honesty becomes part of the work of change. Health systems also have to be willing to learn from the difficult truths that change reveals. If we are not honest about what change disrupts – professional identity, power, or established ways of working – we may mistake resistance for unwillingness, when it may be revealing what the work truly requires. 

Göran challenged the assumption that existing structures still fit. He kept returning to the design of our “houses”, the physical and organisational spaces of healthcare. Hospitals, he argued, have been designed around particular kinds of care, particular workflows and particular assumptions. Yet the work of health is changing. If libraries and museums can redesign themselves around changing expectations for access, learning and participation, why do healthcare spaces so often remain organised around inherited models of service delivery? 

Buildings, beds, roles, resources and reporting lines are not neutral. They preserve assumptions about what care is, where health happens, who holds responsibility and what kinds of change are imaginable. Göran’s challenge was to learn from what no longer fits.

Towards the end, I asked each guest what they were still curious about. 

April wondered about care models that move beyond individual interactions between a medical provider and a patient, towards community care, shared learning and shared support. Sarah wondered about the conversations needed to move toward preventive health, especially when prevention can feel counter-cultural or threatening. Göran wondered how resources for health might be more democratically led, and whether non-traditional actors could take responsibility for resources traditionally held by the healthcare system. 

Their curiosities differed in scale and emphasis but seemed to point to a harder question: not whether health systems can listen, but whether they are willing to be changed by what they hear. 

It is one thing to name the need for change; it is another to step into it. Action can mean uncertainty, exposure, or giving up control before the new way is clear. If leaders want people to move from naming change to entering change, they have to create conditions where that step feels possible: room to test without being abandoned; honesty about what change may cost; and permission to take a smaller bite of the elephant rather than being asked to swallow the whole thing at once. 

After the recording, Göran saw my printed notes and smiled. “It’s good to plan,” he said, “but we do not have to follow the plan.”

I laughed then, because my plan had so clearly not been followed. But the line stayed with me. 

Health systems often plan for change as though the path can be known in advance. Yet the work of learning, adapting and renewing may depend just as much on our ability to notice what is emerging in practice: what communities are telling us, what staff are struggling to say, and what old structures are making difficult to imagine. 

I began the podcast with a question about how health systems learn. I left with a different appreciation of the practice of learning itself: prepare carefully, listen generously, and be willing to be changed by what the conversation reveals. 

 

You can listen to the podcast conversation that changed the plan and inspired this reflection here: https://open.spotify.com/episode/3iAwh9NMRkAIlGJNAzPFIA

This blog is contributed by the Centre for Healthcare Innovation, Singapore.

April Kyle was an invited guest of CHI during the annual CHI Innovate Conference
Sarah Woolnough and Göran Henriks are both members of the CHI Leadership Council. 

The CHI Leadership Council is an international advisory panel comprised of distinguished thought leaders in their respective fields, committed to pioneering systems innovation and driving change. They provide thought leadership to CHI and its partners in spearheading transformation across the health system, while fostering co-learning, collaborations, and facilitating innovation.

Author

Vanessa Audris Lim

Vanessa is an Assistant Director in Learning and Organisation Development at the Centre for Healthcare Innovation (CHI), Singapore, where she works with leaders and health systems to build capability for learning, adaptation and change. She co-leads CHI’s Future Leaders and Young Innovators Guild (CHI FLYING) and is most interested in questions that have life in them: the kind that make people pause, look again, and occasionally make the plan leave the room.  

Declaration of Interests 
The author declares no conflict of interest in relation to this article.